Leicester Royal Infirmary

About: Leicester Royal Infirmary is a healthcare organization based out in Leicester, United Kingdom. It is known for research contribution in the topics: Population & Carotid endarterectomy. The organization has 5300 authors who have published 6204 publications receiving 208464 citations.

Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases.

Abstract: This article presents the recommendations of the European Society of Musculoskeletal Radiology Arthritis Subcommittee regarding the standards of the use of MRI in the diagnosis of musculoskeletal rheumatic diseases. The recommendations discuss (1) the role of MRI in current classification criteria of musculoskeletal rheumatic diseases (including early diagnosis of inflammation, disease follow-up, and identification of disease complications); (2) the impact of MRI on the diagnosis of axial and peripheral spondyloarthritis, rheumatoid arthritis, and juvenile spondyloarthritis; (3) MRI protocols for the axial and peripheral joints; (4) MRI interpretation and reporting for axial and peripheral joints; and finally, (5) methods for assessing MR images including quantitative, semiquantitative, and dynamic contrast-enhanced MRI studies.

Chemotherapy for advanced, recurrent or metastatic endometrial carcinoma

Abstract: Background Although endometrial adenocarcinoma is a common gynaecological cancer, a comparatively small proportion of patients present with, or develop, recurrent or advanced disease. However, for those women whose disease does progress or recur the prognosis is poor and the best treatment is yet to be identified. Co-morbidity, including obesity and cardiac disease, and concerns over toxicity have prevented more extensive studies of cytotoxic chemotherapy, although there are a number of active agents. Objectives To assess any benefits or adverse effects of cytotoxic chemotherapy in women with advanced, recurrent or metastatic endometrial adenocarcinoma. Search methods Systematic searches of MEDLINE, EMBASE, CENTRAL and the Cochrane Gynaecological Cancer specialist trials register were conducted to identify all eligible randomised controlled trials (RCTs).Databases were searched from 1966 to January 2012. Literature searches were supplemented with searches of relevant trials registers and conference proceedings. Selection criteria RCTs comparing chemotherapy versus another intervention (including different chemotherapy) in advanced disease were considered. Trials of adjuvant treatment or for sarcomatous tumours were excluded. Data collection and analysis Data were extracted from the papers by review authors and authors of included studies contacted for further information. Main results Fourteen eligible trials, which recruited patients between 1974 and 2005, were identified, eight of which compared 'more' with 'less' chemotherapy. Results from these eight trials, including 1519 patients, showed that treatment consisting of 'more' chemotherapy was associated with longer overall survival (OS) (hazard ratio (HR) 0.86; 95% confidence intervals (CI) 0.77 to 0.96; P = 0.005) and with longer progression-free survival (PFS) (n = 1526; HR 0.82; 95% CI 0.74 to 0.90; P Authors' conclusions This review suggests that more-intense chemotherapy regimens may improve both OS and PFS for women with advanced or recurrent endometrial cancer. However, owing to inconsistencies between cytotoxic drug combinations that have been assessed in randomised trials to date, the optimum regimen has still to be defined. Future trials should aim to include measures of quality of life (QoL) and symptom control in addition to survival and progression outcomes.

Variability of time-domain indices of dynamic cerebral autoregulation

Abstract: The intra- and inter-subject variabilities of the cerebral dynamic autoregulatory index (ARI) were studied in a group of 14 healthy subjects aged 23–51 years. An alternative index, derived from autoregressive-moving average (ARMA) modelling of the arterial blood pressure (ABP)–cerebral blood flow velocity (CBFV) dynamic relationship, named ARMA-ARI, is also proposed. The susceptibility of both indices to physiological sources of variability was studied by performing measurements during spontaneous respiration (SR), and controlled breathing at 6, 10 and 15 breaths min−1. ABP was measured non-invasively (Finapres), CBFV was recorded with Doppler ultrasound in both middle cerebral arteries and end-tidal CO2 (EtCO2) was estimated with an infrared capnograph. ARI and ARMA-ARI were calculated as a summary measure for the whole of each recording period, and also continuously, using a 60 s moving data window. Respiration did not have an effect on either of these indices, despite significant, but relatively small, reductions in EtCO2 at 10 and 15 bpm, compared to SR. Very significant differences were observed between ARI and ARMA-ARI in relation to their stability, variability and sensitivity to discriminate between subjects. For continuous estimates the coefficient of variation of ARI was 30 ± 21% compared to 15 ± 8% for ARMA-ARI (p < 0.000). The cumulative probability distributions were also significantly different for the two indices for each of the respiratory manoeuvres. The greater stability and reduced variability of ARMA-ARI, in relation to the classic ARI, suggest that the former should be used in future studies of dynamic autoregulation, mainly in situations where an improved temporal resolution might be required, such as the investigation of vaso-vagal syncope or the physiology of exercise.